Safety, Prevention and Treatment from Burns

Burns in South Africa: Who is at risk?

There is a high incidence of burn injuries in South Africa. The root causes of this need to be addressed, but simply being aware of the risks is enough to increase vigilance and prevention.

Burns are extremely painful, often life threatening injuries that take a long time to heal and often leave the victim with serious, lifelong scarring. South Africa has a particularly high rate of childhood burns, with as many as 1 300 burn-related deaths each year – and this incidence peaks in the winter months when coal-burning fires are used to heat low-income homes. By being aware of the main risk factors for childhood burns in this country, it’s possible to reduce those risks and keep children – and adults – safe.

“Aside from the pain and the emotional and physical costs of treatment and hospitalisation, there is a lot of guilt associated with childhood burns – because the children are often scarred, because the burn usually happens within the home and because the child is usually very young and parents feel that they should have been more vigilant,” says Thokozile Nzama, Senior Partner in charge of marketing at Umsinsi Health Care. “By looking at when and how burns most frequently occur, we can equip ourselves to address the risks and avoid these terrible outcomes.”

In a review published by the Medical Research Council at Unisa, entitled The Epidemiology of Childhood Burn Injuries in South Africa, the following was revealed:

Children aged six and younger are at particularly high risk for burns.

Toddlers, followed by infants are at greatest risk.

The majority of burn victims are African children – which relates to both the higher proportion of African children in the country and the fact that African families are traditionally of a lower income, and more likely to heat their homes with coal or wood burning fires, and have less space in which to boil water.

Infant scalding are most commonly from hot liquids such as tea, soup or water prepared for cleaning.

Toddler scaldings (of two and three year olds) most often occur when pots, kettles or heating equipment are found on the floor or low tables. They also use electrical cables to pull themselves up, which results in hot liquid spills.”

Three year olds also start to show burns from other sources, suggesting that they begin to spend more time outside of the home where they are not directly supervised by adults at this age.

While advances in medical science have meant that burn treatment protocols are improving all the time, nothing can take away the initial extreme pain and fear that comes with a burn injury.

“While we all have to keep working together to find ways to make our homes safer for our children, vigilance and common sense are the tools that we all have at our disposal right away,” says Nzama. “If you have a child of a certain age who has access to the risky items or areas that we’ve mentioned, do your best to secure that area and prevent the child from accessing any dangerous heating devices, liquids or cords.”

By working together, finding solutions and creating awareness, we can succeed in bringing down South Africa’s unacceptably high rate of burn injuries.

This is the first in a series of articles that will also cover burn treatment, burn prevention, burn after-care and the South African health care system’s burn capacity and protocols.

Don’t get burnt this winter!

In the winter months, it is important to be super-vigilant to keep children from getting burnt by heaters, fires, hot water and hot plates. It is vital that parents and teachers educate themselves and then educate their children to reduce the incidence of burns in South Africa.

In South Africa, winter is burn season. And in burn season, the people who most often suffer these painful injuries are children. While no parent should ever feel guilty about the circumstances leading to a child getting accidentally burnt, there are many steps that can be taken to make a home more safe for a child – especially in the winter months.

“The first step in preventing burns is being supervigilant,” says Thokozile Nzama, senior partner in charge of marketing at Umsinsi Health Care. “Spend some time thinking about the things that burn children – hot plates, hot water, fires – and think about how any of these things are located in your home. Then work out how you can minimise your child’s access to them.”

Burn rates spike in children who are two to three years old and again when children begin school. Both these spikes coincide with a sudden increase in independence, so while it is important to protect a child from burns, it is also important to educate them about what they can and can’t do from a very early age.

These are some of the areas that Nzama says require specific attention:

Hotplates – especially if these are placed on the floor or a low table. It is very easy for a crawling child to reach for a hotplate or fall onto one on the ground. Try to keep hotplates out of reach or behind a barrier.

Kettles. If these are on the floor, the risk of injury is the same as with a hot plate. When these are placed on a low surface, especially if the kettle cord dangles, a child can easily overturn the kettle over themselves.

Any electrical wires that lead to heating devices. Small children see electrical cords as helpful ropes to pull themselves up with. Always make sure that cords lie against the wall with furniture against them, and never dangling off the edge of a table or cupboard.

If your child is in the same room as a fire or heater, never leave them alone and never stop watching them. Remember that a child doesn’t have to be walking or even crawling to be mobile.

Keep lighters, matches and any flammable liquid like paraffin out of your child’s reach. From a very early age, teach them that all these items can hurt them.

Teach your children to Stop, Drop and Roll if their clothes catch on fire as if these steps are taken quickly, they can prevent bad burning.

Speak to your child’s daycare owner, teacher or principal about what in-school educational steps are taken to make children aware of burn risks, and campaign for better education if none exists.

“It’s important to remember that teaching children about avoiding burns is an ongoing process,” says Nzama. “Don’t tell them once, tell them every day. Remind them of the reasons, don’t just expect them to obey you. And even when they seem responsible and cautious, keep being vigilant. It takes a momentary lapse in common sense on their part and attentiveness on yours for something terrible to happen.”

Of course, it’s possible for anyone in a family to suffer a burn injury at any time, so while it’s important to ramp up the vigilance in winter, don’t let your guard down all year round. Stay safe.

Caring for a burn injury in hospital and afterwards

Unfortunately, the treatment for a serious burn isn’t an overnight process. Depending on the severity of the burn, a victim might have to spend a long time in hospital, and will have to continue to care for the injury long after they have been discharged.

Many South African hospitals simply do not have the resources or training to properly manage burn wound care, so it is useful for South Africans to be aware of how serious burns should be treated so that they can demand the best care and help themselves if necessary.

“It’s important to understand that caring for a serious burn requires a multidisciplinary approach because everyone needs to be on their toes, watching for any change and responding to the patient’s needs,” says Thokozile Nzama, senior partner in charge of marketing at Umsinsi Health Care. “Patients will be cared for by doctors and nurses, and they may have other medical specialists involved as well. But it’s important that patients are also aware of how burns should be treated so that they can raise any issues that might come up.”

Keep it covered

The most important factor in burn treatment is to get wounds closed and covered as quickly as possible. Nzama explains that the longer the wound is open, the more likely it is to pick up an infection. “No dressing can heal a wound; they can simply stop the things that slow down healing.”

These factors include physical damage, which occurs every time a dressing is taken off a wound, and temperature damage, which also occurs when the dressing is removed, because the wound needs to warm up again before healing can restart. Also, when a wound is uncovered, there is a greater chance of infection because it is exposed to airborne germs.

“In some hospitals, the night shift will remove burn dressings before they go off-duty in the morning, to prepare for when the doctors do their daily rounds,” says Nzama. “The wound then lies open until the doctor visits – sometimes hours later – exposing the patient to potentially harmful bacteria for extended periods of time.”

There is a new generation of burn dressings that are applied only once and then not removed – allowing for healing to take place underneath. When the wound has healed, the dressings flake away, so wound management, patient outcomes and pain levels are significantly improved. They can even be used in burns where skin grafts are required because they heal as much of the surface as possible, allowing for the smallest area to be grafted.

“It’s important to be aware of products like these – because not all hospitals stock them,” says Nzama. “Research has shown that they significantly improve outcomes and reduce pain levels. Interestingly, in South Africa, they are more likely to be made available in government hospitals than private ones.”

Aftercare for burns

Once the wound has sealed, patients need to remember that the healing journey has not ended and they will need to continue to take care of the site of the injury. “When a burn heals, it’s like a hole in the ground has been filled with rubble and grass has been laid over the top,” says Nzama. “The tissue under the surface is irregular and still has lots of gaps. It can take a year for the wound to heal properly and for all the tissue to connect and even out.”

Because of this, she says it’s vitally important to take care of the wound, even if the surface appears to have healed. She recommends avoiding the sun altogether or, if this is not possible, using a good-quality sunblock on the scar. She says it’s also helpful to use a good moisturiser and to massage gently when it is applied, to help remodel the tissues underneath.

“Burns are frightening and painful for the victim, and unfortunately, healing is a long-term process,” says Nzama. “But by becoming a partner in your own treatment and understanding how to get the best results, you can take away some of the fear and help yourself to heal.”

Burn dressing innovation revolutionises burn care

Burn care is an unappealing health care discipline because recovery is slow and treatment is painful and traumatic. Advances in burn dressings are set to change all this.

Caring for patients with serious burns is traditionally difficult, heartbreaking and physically demanding. The patients look bad, smell bad and sound bad, and the emotional and physical trauma that they experience is transmitted to their caregivers.

Burn care is also a long-term process. There is no quick fix and there are many painful interventions along the way. Add to this that the majority of serious burn victims in South Africa are children, and it’s easy to understand why healthcare workers shy away from this particular discipline.

“There are many things that can be done and are being done in the healthcare system to improve outcomes for patients and retention of healthcare workers in burn units, and chief among these are advances that are being made in burn dressings,” says Thokozile Nzama, Senior Partner in charge of marketing at Umsinsi Health Care.

Previously, burn patients had to undergo dressing changes every day. This process was painful and traumatic for the patient, and demoralising for the healthcare giver – especially if the victim was a child who wasn’t able to comprehend that the process was for their own good.

This care process also slowed down healing because as the dressings were stripped away, many of the new tissues that the victim’s body had grown would be stripped away too.

However, over the past ten years, burn dressings have advanced so that they don’t need to be changed regularly. “Some burn dressings now don’t need to be changed at all,” says Nzama.

Instead, the burn injury is cleaned out under anaesthetic and the intelligent dressing is placed over it. The dressing forms a sealed layer that encourages the tissues to grow beneath it without growing into the dressing. When the burn injury has healed, the dressing flakes off.

“Even if the burn is full thickness, which means it has destroyed both layers of the skin and requires a skin graft, these kinds of dressings can help by healing as much of the surface as possible, so that minimal grafting is required,” says Nzama.

This process completely does away with the need for painful, traumatic dressing changes. While it can’t be used on all burns, it can be used in a significant number of partial-thickness cases, and can help a great deal with full-thickness burn injuries.

“These advanced dressings reduce pain, improve outcomes, reduce scarring and reduce overall trauma for burn victims,” says Nzama. “It’s a privilege to work in an industry at the forefront of these innovations and to be making a significant difference to patients’ care and to the rest of their lives.”

She hopes that with these kinds of advances, burn care will attract more dedicated healthcare workers in future, and this area of healthcare that has been significantly neglected in South Africa will start to get the attention it deserves.

A word of Appreciation to Umsinsi Health Care. Umsinsi Health Care, was established in November 2008 as the sole appointed representative for ConvaTec in Southern Africa. Its commitment to transformation is demonstrated by being the first health care company in SA to give its entire permanent staff the benefits of co-ownership in their own business, Umsinsi Health Care profits remaining after the deduction of operating requirements, investments and social responsibility investments are split between employees, in recognition of the company’s philosophy that those who work hard to make the profits and ensure the sustainability of the business deserve to benefit from those profits in return.